Evaluation of the newborn at birth includes assignment of the Apgar scores at one and five minutes of age. Dr. Virginia Apgar (Figure 1) developed this evaluation procedure in the 1950s, and it has been used routinely for more than a half century. Apgar developed this assessment tool with five objective criteria: (a) heart rate (HR), (b) respiratory effort, (c) reflex irritability, (d) muscle tone, and (e) color (Table 1). Apgar described the criteria, scoring method, and the rationale for each of the five criteria. She stated in her second report that HR and respiratory effort were the most important of the five assessment criteria; that reflex irritability and muscle tone were next in importance; and that color was the least important. She explained that color is dependent on the criteria of HR and respiratory effort. To become pink, an infant needs to be breathing.